STLC-POSP Contract Management Liaison

Job Title: Contract Management Liaison

FLSA Status: (Exempt)

Salary Range: See Pay Scale

Education: Associate degree in accounting, business, healthcare or related field.

Experience: At least 1 years experience working with the frail elderly population. 2+ years Medicaid/Medicare knowledge with at least 2+ years of accounting experience in a medical practice or equivalent business office setting. Experience in a healthcare setting working with medical claims.

Number and Type of Employees Supervised (optional): None.

Licensure, Registry or Certification Required: NC driver’s license.

Special Training: Meet a standardized set of competencies for the specific position description established by Senior TLC, Inc. and approved by CMS before working independently.

Immunizations: Be medically cleared for communicable diseases and have all immunizations up to date before engaging in direct participant contact

Ages of Patients Rendered Care:

Neonate/Infant Early Childhood Adolescent Adult Geriatric All Age Groups

· Supports Senior TLC’s mission to encourage and support the quality of life of seniors wishing to continue living in the community; its vision to be the preferred provider of individualized care for seniors in the community; and its values of respect, integrity, accountability, compatible goals, and compassionate care.

· Provides administrative support for the Director of Finance in being the Liaison for the Pace Program.

· Liaison for Contract Provider Request forms submitted by COO & Medical Director.

· Oversees and maintains the credentialing of all provider and vendor contracts.

· Oversees the Preclusion list of FDR (First Tier Downstream) & related entities to ensure compliance with CMS.

· Assists in conducting annual contract audits.

· Assists in conducting new provider and vendor orientations.

· Maintains contract/vendor files and database.

· Submits contract provider list for annual participant newsletter.

· Maintains and load new contracts within the claims adjudication software.

· Review weekly Pend Reports for contractual requirements for claims adjudication.

· Assists with the internal audit process of claims adjudication software.

· Review claims financial data utilization for contract negotiations.

· Report new contract providers to third-party payer for authorizations.

· Acts as Liaison with local DSS to ensure compliance with State regulations.

· Serves as a backup for the Finance Team as necessary.

· Other duties as assigned by the Director of Finance and Executive Director